Commercializing COVID treatments and vaccines likely means more out-of-pocket health costs

Commercializing COVID treatments and vaccines likely means more out-of-pocket health costs

Sometime in the coming months, Americans will no longer have free access to government-funded COVID tests, treatments, and vaccines. Those tools will move to the private sector — and likely be subject to some of the same access and affordability issues as the rest of the health care system.

Why it matters: After being the exception to the rule for more than two years, COVID will be treated like any other disease. Billions of dollars currently borne by taxpayers will instead be transferred to patients through their premiums and out-of-pocket costs.

Send the news: The Department of Health and Human Services hosted a stakeholder meeting last week on the commercialization process for vaccines and therapies.

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  • “Our goal is to transition the procurement and distribution of COVID-19 vaccines and therapies from a federally managed system to the commercial market in a thoughtful, well-coordinated manner that leaves no one behind,” HHS Assistant Secretary for Preparedness and response Dawn O’Connell wrote in a blog post.
  • The federal government expects funds to buy and distribute vaccines to run out as early as January, O’Connell wrote, and expects the federal stock of several therapies to gradually run out over the course of 2023. When stocks run out, these products will be converted to the private market.
  • One therapeutic — Eli Lilly’s monoclonal antibody treatment — has already gone commercial at a list price of $2,100 per dose, according to the Wall Street Journal.

Of interest: The federal government prohibits some forms of cost-sharing as long as the public health emergency is still in effect.

  • Once that’s lifted, so will these rules (though not for about a year in the Medicaid program). The timing could coincide with when federal supplies run out.
  • “Once the PHE ends, some of these rules currently in effect will also end, and the increased cost-sharing will take effect somewhat immediately,” said KFF’s Jennifer Tolbert.

How it will work: Just like the health system treats any other disease or condition.

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  • Vaccines: Most Americans will probably still get their vaccines for free, because insurers usually cover them with no cost-sharing. However, the price of the vaccines will be reflected in premiums, and patients can pay the vaccine-related costs if they use a third-party provider.
  • To test: The days of low-threshold free COVID tests are numbered. Once the public health emergency is over, people will likely have to pay out of pocket for over-the-counter tests and be able to share the cost of PCR testing, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms.
  • Treatments: Covid therapies such as Pfizer’s antiviral Paxlovid will be “like any other treatment. If you are hospitalized or given a prescription drug, it will be subject to a deductible, coinsurance – it will vary based on treatment.” you need”, Corlette said.

  • The uninsured: It is unclear what alternatives they have if they cannot pay for care out of their own pocket. Certain providers, such as community health centers, may provide services at discounted prices or for free, but “it is safe to say that uninsured individuals will continue to face barriers to access these tests, vaccines and therapies in the future,” he said. Tolbert.

Between the lines: Insurers can choose to restrict who has access to certain treatments, especially antivirals, and different health facilities plans may end up with different policies.

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  • For example, there are still many unclear questions about who benefits from Paxlovid, and how much.
  • “These will be subject to medical necessity determinations,” Corlette said. “In an area where we have this uncertain science, it can be a bit of a struggle whether your plan covers the treatments your doctor wants you to get.”

It comes down to: In the not-so-distant future, costs — including co-payments and deductibles — will become a much bigger consideration when someone needs COVID testing or treatment.

  • “Depending on how health plans decide to structure their cost-sharing, individuals will have to pay the costs entirely on their own until they reach the deductible,” Tolbert said. “That will be a huge barrier for people to access these tests and treatments.”

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